Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2022; 10(33): 12146-12155
Published online Nov 26, 2022. doi: 10.12998/wjcc.v10.i33.12146
Different positive end expiratory pressure and tidal volume controls on lung protection and inflammatory factors during surgical anesthesia
Yu Wang, Yi Yang, Ding-Mu Wang, Jie Li, Quan-Tang Bao, Bei-Bei Wang, Shu-Jun Zhu, Lu Zou
Yu Wang, Ding-Mu Wang, Quan-Tang Bao, Bei-Bei Wang, Shu-Jun Zhu, Department of Anesthesia, Xinghua City People's Hospital, Xinghua 225700, Jiangsu Province, China
Yi Yang, Department of Anesthesiology, Suzhou High-Tech Zone People's Hospital, Suzhou 215011, Jiangsu Province, China
Jie Li, Naval Medical Center, Naval Medical University, PLA, Shanghai 200433, China
Lu Zou, Department of Anesthesiology, Changzhou Hospital of Traditional Chinese Medicine, Changzhou 213000, Jiangsu Province, China
Author contributions: Wang Y and Yang Y have the same contribution to this article and should be regarded as the co-first author; Wang Y, Yang Y and Wang DM design the experiment; Li J drafted the work, Bao QT, Wang BB and Zhu SJ collected the data; Yang Y, Zou L and Wang Y analysed and interpreted data, Wang Y, Yang Y, Wang DM and Li J wrote the article.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Xinghua City People's Hospital.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors declared that there is no conflict of interest between them.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Lu Zou, MD, Associate Chief Physician, Chief Doctor, Department of Anesthesiology, Changzhou Hospital of Traditional Chinese Medicine, No. 25 Heping North Road, Tianning District, Changzhou 213000, Jiangsu Province, China. baobao01013812@163.com
Received: June 22, 2022
Peer-review started: June 22, 2022
First decision: July 13, 2022
Revised: July 27, 2022
Accepted: October 20, 2022
Article in press: October 20, 2022
Published online: November 26, 2022
Processing time: 154 Days and 1.2 Hours
Abstract
BACKGROUND

Mechanical ventilation can lead to the severe impairment of the metabolic pathway of alveolar surfactants, inactivating alveolar surfactants and significantly reducing lung-chest compliance. The cardiopulmonary function of elderly patients usually reduced to a certain extent, and there are lung complications after surgical anesthesia, just like lung barotrauma caused by mechanical ventilation, atelectasis and postoperative hypoxemia.

AIM

To investigate the effects of different positive end expiratory pressures (PEEPs) and tidal volumes (VTs) on respiratory function, the degree of the inflammatory response and hemodynamic indexes in patients undergoing surgery under general anesthesia.

METHODS

A total of 120 patients undergoing surgery for gastric or colon cancer under general anesthesia in Xinghua People's Hospital from January 2017 to January 2021 were randomly divided into Group A and Group B, with 60 cases in each group. The ventilation mode in Group A was VT (6.0 mL/kg) + PEEP (5.0 cmH2O), while that in Group B was VT (6.0 mL/kg) + PEEP (8.0 cmH2O). Blood gas parameters, respiratory mechanical parameters, inflammatory response indicators, hemodynamic indicators and related complications were compared between the two groups.

RESULTS

There were no significant differences in PaCO2, PaO2, oxygen or the examined indexes at T0 between group A and group B (P > 0.05). The measured PaO2 value of patients in group A at T3 was higher than that in group B, and the difference was significant (P < 0.05). There were no significant differences in peak airway pressure (Ppeak), mean airway pressure or dynamic pulmonary compliance (Cdyn) at T0 between group A and group B (P > 0.05). The measured Ppeak value of patients in group A at T1 was higher than that in group B, and the difference was significant (P < 0.05). The measured Cdyn value at T1 and T2 was greater than that in group B (P < 0.05). Before surgery, there were no significant differences in tumor necrosis factor-α (TNF-α), interleukin (IL)-6 or IL-10 between group A and group B (P > 0.05). After 4 h, the measured values of TNF-α and IL-6 in group A were lower than those in group B, and the differences were significant (P < 0.05). The IL-10 Level in group A was higher than that in group B (P < 0.05). At T0, there were no significant differences in cardiac output, cardiac index (CI), stroke volume index (SVI) or mean arterial pressure between group A and group B (P > 0.05). The measured values of CI and SVI at T2 in patients in group A were higher than those in group B, and the differences were significant (P < 0.05).

CONCLUSION

For patients undergoing surgery for gastric or colon cancer under general anesthesia, the VT (6.0 mL/kg) + PEEP (5.0 cmH2O) regimen was more effective than the VT (6.0 mL/kg) + PEEP (8.0 cmH2O) regimen in protecting the lung function and ventilatory function of patients, and it had better effects on maintaining hemodynamic stability and reducing inflammatory reactions.

Keywords: General anesthesia; Positive end expiratory pressure; Tidal volume; Respiratory function; Inflammatory reactions; Hemodynamics

Core Tip: A retrospective study proved that for patients undergoing surgery for gastric or colon cancer under general anesthesia, the tidal volume (VT) (6.0 mL/kg) + positive end expiratory pressure (PEEP) (5.0 cmH2O) regimen is better than the VT (6.0 mL/kg) + PEEP (8.0 cmH2O) regimen Can more effectively protect the patient's lung function and ventilation function.